What is my copayment?

Depending on your income, you may have copayments for things such as prescription drugs and visits to the doctor or emergency room. Copayments range from $3 to $25 for doctor office visits. The copayment is the portion of the bill that you have to pay.

How can I tell if my child’s current doctor, clinic, or hospital is in the Texas Children’s Health Plan’s provider network?

You can use our “Find a Doctor” tool, or call our toll-free number at 1-866-959-6555.

How do I pick a main doctor?

You can use our “Find a Doctor” tool to find a main doctor. If you can’t find your doctor, or need help choosing one, call Member Services at 1-866-959-6555. Your main doctor is your “medical home” for health care. Your main doctor can arrange specialty care as needed.

How do I get well-child checkups?

You can get well-child checkup services from your main doctor. It’s important to take your child to get his or her checkup every year.

How do I get prescriptions?

To find out which drug stores are in our network, you can call Member Services at 1-866-959-6555 or review our list of pharmacies in our pharmacy directories.

How do I find participating providers to get lab testing, medical supplies and/or medical equipment?

For a list of these types of services, call Member Services at 1-866-959-6555.

How do I get behavioral (mental) health and substance treatment?

You can get behavioral (mental) health and substance services without a referral from your main doctor. You can use our “Find a Doctor” tool to find one near you. To use these services, call Texas Children’s Health Plan toll-free at 1-800-731-8528.

How do I get specialist care?

Sometimes your main doctor may not be able to offer you the treatment you need because it is not their specialty. In this case, your main doctor can refer you to a specialist. Specialists are listed in our "Find a Doctor" tool.

How do I get routine eye exams for my child?

You can get eye exams without a referral from your main doctor. To use these services, call Block Vision at 1-800-879-6901.

How do I find out about health fairs or events Texas Children’s Health Plan is having?

To find out about events in your area, call 1-800-990-8247 or visit our events page.